How to Tell If You Need a Folate Supplement

Your body depends on a steady supply of nutrients to operate the way it’s intended to. Ideally, those nutrients would solely come from food, but there are certain conditions that may make supplementation necessary. Folate is one nutrient that some individuals may need to supplement. 

So how do you know if you could benefit from a folate supplement—or if your diet already provides enough? We spoke with dietitians to find out when a folate supplement might be helpful and how to use them safely.

What Is Folate and Why Does It Matter?

Folate is one of eight B vitamins that help to sustain several of your body’s most important processes. This vital vitamin supports DNA production, red blood cell formation, cell growth and brain function, says Carolina Schneider, M.S., RD. Folate is especially important during certain stages of life, such as pregnancy, when the body’s demand for this nutrient increases to support healthy fetal growth and development. Beyond the prenatal stage, Schneider highlights that folate also helps to regulate homocysteine, an amino acid that, when elevated, can contribute to cardiovascular and cognitive issues.,

Maintaining adequate folate intake is crucial. “It’s an essential nutrient, meaning we can’t make it ourselves—we have to get it through food or, in some cases, supplements,” she explains. 

However, not all folate is the same. “The naturally occurring form in food is called folate, while the more stable form added to supplements and fortified foods is folic acid, which the body absorbs more easily,” says Schneider. She adds that some supplements use methylated folate (5-MTHF), the active form the body can use directly. “This form may be helpful for individuals with certain MTHFR gene variants or those who have trouble metabolizing folic acid.”

How Much Folate Do You Need?

Your daily folate needs change with age and life stage. For the average adult, including women of childbearing age, the recommended dietary allowance of folate is 400 micrograms, says McKenzie Caldwell, M.P.H., RDN., Once pregnancy begins, needs rise to 600 mcg per day. During postpartum and lactation, the folate requirement is 500 mcg per day to maintain maternal and infant health.,

Food Sources of Folate

Fulfilling your daily folate needs can be achieved by eating a wide array of leafy greens, beans, legumes, fruit and fortified foods. Some examples of foods rich in folate include:

• Leafy Greens: Spinach, mustard greens, turnip greens
• Beans and Legumes: Black-eyed peas, edamame, chickpeas, lentils, kidney beans, green peas
• Vegetables: Asparagus, Brussels sprouts, broccoli, okra, beets, cauliflower
• Fruits: Avocado, oranges, papaya, banana
• Nuts and Seeds: Sunflower seeds, peanuts
• Fortified Grains: Breakfast cereal, pasta, bread, rice, tortillas.

Who Might Benefit from a Folate Supplement

While most people can meet their daily folate requirements through food alone, certain groups may benefit from supplementation. However, before adding a new supplement to your routine, you should speak with a health care provider to ensure the form and dose are right for your needs.  

People with Absorption Issues

Certain health conditions can affect how well your body absorbs folate. “This includes individuals with conditions like celiac disease or inflammatory bowel disease (IBD),” says Schneider. In fact, 20% to 60% of people with IBD, including Crohn’s disease or ulcerative colitis, have a folate deficiency.

Other conditions that reduce stomach secretions, such as gastritis and gastric surgery, can also impair folate absorption. Supplementation in these cases can help prevent deficiency and support optimal folate levels.

Women of Reproductive Age and During Pregnancy

Women of reproductive age—even those not actively planning a pregnancy—should consider a folate supplement or prenatal vitamin. “The early weeks of pregnancy are when folate is most critical for fetal [spine, brain and skull] development, and many people don’t know they’re expecting until after that window has passed,” says Schneider. Caldwell adds that taking a multivitamin or prenatal with folate during the childbearing years and pregnancy can help reduce the risk of neural tube defects, such as spina bifida, anencephaly and encephalocele.

Individuals with Alcohol Use Disorder

People who consume alcohol in excess may also benefit from a daily folate supplement. “This population often has poor dietary intake, and alcohol interferes with folate absorption and metabolism in the body,” says Caldwell. Alcohol speeds up the breakdown of folate and increases its loss through urine. For this reason, people with alcohol use disorder often require folate supplementation to help replenish their stores.

Signs of a Folate Deficiency

Folate deficiency can show up in subtle ways that are often overlooked. “One of the most common symptoms of folate deficiency is fatigue, since folate is needed to make healthy red blood cells,” says Schneider., People may also experience weakness, shortness of breath, dizziness or difficulty concentrating. Other signs may include changes in skin, hair or fingernail color, mouth sores, a swollen or tender tongue or reduced sense of taste.,

Since folate and vitamin B12 deficiencies can look very similar, Scheider recommends confirming a folate deficiency with blood work to ensure the right treatment.

Potential Risks of Folate Supplements

Folate supplements are generally safe for most people, but high doses—usually above 1,000 mcg—carry some risk. “Concerns generally come up only with very high doses of folic acid from supplements, well above what you’d find in a typical multivitamin or prenatal,” explains Schneider. “At those extremely high levels, folic acid can sometimes mask the signs of a vitamin B12 deficiency.” If left untreated, B12 deficiency can lead several health issues, including irreversible nerve damage.

Caldwell adds that taking too much folic acid has also been linked to a higher risk of colon cancer and potential negative cognitive effects in young children and older adults. However, more research is needed to fully understand the relationship between unmetabolized folic acid, cancer and cognitive outcomes.

Our Expert Take

Folate plays a vital role in building and repairing DNA, producing red blood cells, supporting cell growth and assisting in proper fetal development. While most people can meet their needs through folate-rich foods—like leafy greens, beans, fortified grains and fruits—certain groups may need an extra boost from a daily folate supplement. These include people of reproductive age, pregnant individuals, those with absorption issues and those who consume alcohol heavily. Taking a folate supplement at the proper dosage can protect against deficiency, but it’s important to consult a health care provider to determine the proper form and dosage for your unique needs.